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They have gone home with aching backs and, in worst-case scenarios, ended up in hospitals themselves.

"In the course of an eight-hour day, a nurse will typically lift 1.8 tons, which is pretty astronomical," said Amy Williamson, a workplace safety coordinator for Baptist Hospital here.

The official guideline from the National Institute for Occupational Safety and Health is that nurses should lift no more than 35 pounds at any given time, but few hospitals and nursing homes follow that rule.

Back injuries to health-care workers cost billions of dollars annually and are a primary reason for nurses choosing to leave the profession. A 2011 health and safety survey from the American Nurses Association showed that disabling injuries from lifting are a top concern among 62 percent of nurses. Eight in 10 nurses said muscle and joint pain is a frequent occurrence.

"You are boosting patients in bed," said Williamson, whose hospital has received national recognition from the Occupational Safety & Health Administration for its efforts to prevent workplace injuries. "You are turning them. You are trying to assist them to the restroom. It has really taken a toll on our nurses and our techs."

Latashia McGee, 32, of Nashville came to Baptist Hospital in respiratory failure and suffering from diabetes, congestive heart failure, chronic sleep apnea and high blood pressure.

She was too weak to move on her own, but too big for a nurse to lift.

"I was retaining a lot of fluid," McGee said. "They got about 23 liters of fluid off of me," more than 50 pounds.

Nearly two-thirds of the people admitted to Baptist in the past two years weighed 200 to 299 pounds. About 2,200 patients weighed 300 to 499 pounds.

A few years ago, a nursing team faced with a heavy patient would have assembled three or four staff members for a group heave. Today, they wheel in a portable lift. Baptist has invested in portable lift devices that can handle up to 600 pounds and has one on order with a 1,000-pound capacity.

One nurse at Baptist wound up having to undergo three surgeries for a neck injury, torn rotator cuff and carpal tunnel issue. So, almost three years ago, Baptist launched a pilot project to prevent these injuries.

The campaign began in the unit where Mary Ann Baylor is nurse manager. It relied on three key components: equipment, training and awareness.

"We have not had any injuries since our pilot," Baylor said. "It's really a team project. We buddy up so that whenever we are using the lift, the chance of injury is nil. You can't afford to have everybody out sick."

The buddy approach — matching up a new user with someone skilled at using the lift devices — boosted compliance. Baptist wound up reducing its patient handling injuries by more than 74 percent from 2008 to 2011.

"Manual patient handling is unsafe and directly responsible for musculoskeletal disorders suffered by nurses," said Jemarion Jones, a spokesman for the national organization. "Patient handling can be performed safely with the use of assistive equipment."

The portable devices can pick up patients weighing up to 400 pounds while ceiling-mounted lifts can pick up more.

Besides preventing back injuries for hospital staff, the devices lessen the likelihood of patient injuries and give caregivers greater options for moving patients around to prevent bedsores.

To accommodate the increasingly obese patient population, hospitals also have had to invest in braces for toilets, bariatric bedside commodes and chairs designed to bear extra weight.

"You can have someone who is complete total care that is 500 to 600 pounds," Baylor said.

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